Evaluation of Management of Community Acquired Pneumonia Prior to Implementation of an Antimicrobial Stewardship Program Initiative: A Retrospective Assessment

Abstract

Background. Community acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality in the United States. Studies have shown that interventions such as shorter antibiotic therapy and early intravenous (IV) to oral conversion can be safely performed. We evaluated areas of improvement at our institutions that could help optimize patient management while reducing collateral damage associated with excessive antibiotic usage. Methods. In this retrospective analysis, all patients aged 18 years and older with a primary ICD-9 code for CAP admitted 1 March 2014 to 31 October 2014 were analyzed. The primary outcome was duration of antibiotic therapy for CAP (appropriate treatment duration defined as 5-7 days). Secondary objectives included duration of intravenous antibiotic therapy, duration of inpatient length of stay, and 30-day readmission rate related to CAP. Results. Of the 141 patients evaluated, 98 patients met inclusion criteria. The mean age was 63.8 (SD: 16.9 years). Chronic lung disease was present in 53 (54%) of patients, while 17 (17.4%) required use of supplemental oxygen at home. The primary and secondary outcomes can be seen in the table. Outcomes are presented as means; SD = standard deviation. Conclusion. We were surprised to identify the treatment duration in our cohort was 10 days of therapy. Our findings are concerning given the available data demonstrating that short-course therapy with 5-7 days is clinically as effective as long-course therapy and associated with fewer adverse events. The management of CAP represents a significant opportunity for antimicrobial stewardship intervention. (Table Presented) .